A rare case of umbilical and vaginal metastasis from endometrial cancer--review of the literature.

Introduction: Metastases from primary endometrial cancer to the umbilicus are extremely rare. This unusual site of metastases has been described as Sister Joseph's nodule.

Material And Method: We present a case of a 73-year-old Caucasian woman with a BMI of 30, type II diabetes mellitus, hypertension, and umbilical and vaginal metastasis of endometroid endometrial adenocarcinoma (FIGO Stage IIIa, G2). Total abdominal hysterectomy and bilateral salpingo-oophorectomy by Pfannenstiel dissection, had been performed eight months before. The size of the umbilical mass was 2 x 2 cm. A second laparotomy including full recession of the umbilical ring, omentectomy, bilateral inguinal lymph nodes and excision of the upper one-third of the vagina was performed. Histological diagnosis revealed metastases of the same origin with her primary disease.

Conclusion: The exact mechanism of implantation of cancer cells at the site of the umbilical ring is still unclear. Perhaps malignant cells penetrated the thickness of the uterine wall and spread intraperitoneally to reach the umbilical ring. The exfoliation of cells from the primary tumor via the fallopian tubes could be another possible explanation. Unfortunately, the presence of umbilical metastasis is a poor prognostic feature and sign of advanced neoplastic disease. The survival rate of these patients is influenced by the type of treatment and time of the diagnosis.